Collodion baby
A collodion baby is a newborn encased in a tight, shiny membrane that resembles collodion, a material often used in photography. This membrane typically begins to slough off within 10 to 14 days, revealing the underlying skin, which may be abnormal. The occurrence of collodion babies is estimated at about 1 in 100,000 births, and in some cases, around 10% may experience self-healing with normal skin underneath. Conditions often associated with this phenomenon include lamellar ichthyosis and nonbullous congenital erythroderma, as well as several rarer genetic disorders affecting skin integrity. The membrane can create significant challenges, such as increasing the risk of infections, dehydration, and difficulties with feeding and breathing due to its tightness.
Treatment for collodion babies requires specialized care in a neonatal intensive care unit, where they are placed in a humidified incubator, receive intravenous fluids, and may be fed through a tube. The primary goal of treatment is to keep the skin soft and moist, employing emollients and, when necessary, topical steroids to manage inflammation. Through dedicated medical intervention, many collodion babies can achieve improved health outcomes.
Collodion baby
Disease/Disorder
Anatomy or system affected: Hair, nails, skin
Definition: A baby is born encased in a tight, shiny membrane.
Key terms:
desquamation: shedding of the outer layer of skin
epidermis: the outer epithelial layer of the skin
hyperkeratosis: excessive proliferation of skin cells accompanied by accelerated sloughing
Causes and Symptoms
At birth, collodion babies are encased in a tight, translucent, shiny membrane that resembles a “collodion,” or a sausage skin. This membrane sloughs (desquamates) in 10–14 days to reveal the abnormal skin underneath. Ten percent of collodion babies are “self-healing” collodion babies. In such cases, normal skin underlies the collodion, and peeling of the membrane leads to healing and normal skin. The incidence of collodion baby is unknown, but occurs at an estimated rate of 1 in every 100,000 births.
The two most common diseases associated with collodion babies include lamellar ichthyosis and nonbullous congenital erythroderma. Other rarer conditions associated with collodion babies include Sjögren-Larsson syndrome, Gaucher disease type 2, Hay-Well syndrome, trichothyodystrophy, Comel-Netherton syndrome, ectodermal dysplasia, and neutral lipid storage disease. All of these diseases result from mutations in genes that play integral roles in establishing and maintaining the outermost layer of the skin (epidermis). Dysfunctional skin cells cause accelerated turnover and thickening of the skin (hyperkeratosis).
The sloughing of the collodion membrane reveals red, scaly skin underneath. In many cases the scaling has a plate-like appearance that resembles fish scales, but the exact nature of the scaling depends on the type of skin disease responsible for the collodion membrane. As the collodion membrane dries, it cracks. The resulting fissures compromise the barrier function of the skin, and put the baby at increased risk of infections, dehydration, and overheating or cooling. Also, the tightness of the collodion membrane physically restricts underlying tissues. These constraints can prevent the baby from properly suckling and feeding, restrict blood flow in the limbs, affect breathing, and turn the lower eyelids away from the eyeball (ectropion).
Treatment and Therapy
After birth, collodion babies are transferred to a neonatal intensive care unit and placed in a humidified incubator. During their time in the incubator, they are given intravenous fluids and fed through a feeding tube. The goal of treatment is to keep the skin soft and moist to reduce scaling. Emollients such as petrolatum are smeared on the skin to moisten it. A mild topical steroid treatment can reduce inflammation, and artificial tears can ameliorate severely dry eyes in the cases of severe ectropion.
Bibliography
Harrison, V. C. The Newborn Baby. Capetown: Juta, 2012. eBook Collection (EBSCOhost). Web. 17 Mar. 2015.
Kinai, Miriam. Dermatology: Ichthyosis. Seattle: Amazon Digital Services, 2012.
Polin, Richard A., and Alan R. Spitzer. Fetal and Neonatal Secrets. 3rd ed. Philadelphia: Mosby, 2013.
Prado, Renata, et al. "Review: Collodion Baby; An Update with a Focus on Practical Management." Jour. of the Amer. Acad. of Dermatology 67 (2012): 1362–1374. Digital file.
Rubio-Gomez, Gustavo A., Miriam Weinstein, and Elena Pope. "Original Article: Development of a Disease Severity Score for Newborns with Collodion Membrane." Jour. of the Amer. Acad. of Dermatology 70 (2014): 506–511. Digital file.